Clinical Services Coordinator, Advanced (Bilingual)

Blue Shield of California•Long Beach, CA

3d•Hybrid

About The Position

The Behavioral Health Utilization Management team provides utilization management and support for members seeking behavioral health treatment. The BHT Clinical Services Coordinator will report to the Supervisor of Behavioral Health Utilization Management. In this role you will assist the member, family and/or caregiver, and provider in the treatment and management of BHT services, in consultation with a Board-Certified Behavior Analyst (BCBA). Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Requirements

Requires a minimum of 5 years of experience.
Requires broad knowledge of operational systems and practices typically gained through extensive experience and/or education
Requires a High School diploma or equivalent
Bilingual English to Spanish
Ability to enter data into the computer and extract information from databases required
Excellent communication skills with individuals internal and external to BSC including physicians, members, patients, and service providers required
Ability to assist the member, family and/or caregiver, and provider in the treatment and management of BHT services, in consultation with a Board-Certified Behavior Analyst (BCBA) required
Ability to identify problems and work towards problem resolution independently, seeking guidance as needed
Ability to represent the health plan in a professional and knowledgeable fashion
Ability to express ideas clearly in both written and oral communications

Nice To Haves

May require vocational or technical education in addition to prior work experience

Responsibilities

Provide telephonic triage and care management assistance to members seeking access to the Behavioral Health Therapy (BHT) benefit
Process faxed/phoned in authorization requests, UM/CM requests and/or calls left on voicemail
Select support for Case Manager such as mailings, surveys
Data entry including authorization forms, high risk member information, verbal HIPPA authorizations, information for case creation, in consultation with the Board-Certified Behavior Analyst (BCBA)
Support to Advanced/Specialist Clinical Services Coordinator
Assign initial EOA days, or triage to clinicians, based on established workflow
Research member eligibility/benefits and provider networks
Be responsible for establishing trusting relationships with members while providing person-centered support and services
Provide members and/or family members with care coordination, generate referrals to contracted ancillary service providers and community agencies in collaboration with the member’s provider
Document assessments, referrals, and case notes in the electronic case management and tracking systems within the established department guidelines